Stroke: A killer that can be tamed

Full-blown strokes are often preceded by temporary blockages of
blood flow to the brain, said Dr. Edward Pillar, chairman of the
emergency department for Southwest Healthcare System. Southwest
operates Inland Valley Medical Center and Rancho Springs Medical
Center, which is in Murrieta.

These "transient ischemic attacks," or TIAs, cause strokelike
symptoms that disappear on their own. They are a signal to get
examined quickly, Pillar said.

"It's the body's warning sign," like angina, or chest pains, as
a warning sign for heart attacks, Pillar said.

Usually, patients with TIAs show no signs of stroke damage, but
the symptoms alone are enough to help doctors prepare a "care plan"
to reduce the risk of stroke. The doctor will look for risk factors
in the patient's life, as well as examine the patient's family
history to see if there' s a history of stroke in his or her
relatives.

In many cases, the stroke-preventing steps are easy to take.
"Something as simple as taking a low-dose aspirin a day can have an
enormous effect on the outcome," Pillar said.

How stroke happens

About 70 percent to 80 percent of strokes are caused by a blood
clot. The remainder are caused by bleeding, according to the
American Heart Association.

Both types of strokes are caused by deteriorating blood vessels,
said Tri-City's Schim, who is president of the San Diego Stroke
Council. Every beat of the heart sends blood coursing down
arteries, through extremely small vessels called capillaries, to
the lung, and eventually back to the heart. That's a lot of
plumbing to maintain.

High blood pressure subjects blood vessels to greater wear and
tear, which can weaken them and lead to bursting. Atherosclerosis,
or hardening of the arteries, is a buildup of fatty deposits that
roughen the blood vessel, which can cause clot formation.

Inherited weaknesses in blood vessels or the heart can also lead
to strokes.

Price's stroke was caused by a blood clot, and that was lucky
for him. Bleeding strokes are the most dangerous kind. Such a brain
hemorrhage killed President Franklin D. Roosevelt in 1945. This
year, Israeli Prime Minister Ariel Sharon had a bleeding stroke
that nearly killed him. Sharon is still comatose.

Cardiac connection

Stroke is closely associated with heart attacks, because both
are injuries to the cardiovascular system. When blood vessels get
blocked in the heart, it cuts off oxygen to heart muscle, killing
part of the heart. Much the same process occurs with a blocked or
ruptured blood vessel in the brain.

One good side effect of this connection is that half a century
of aggressive treatment for cardiovascular disease has reduced the
rate of stroke by 75 percent, Palomar Pomerado's Stein said. These
include treatments for high blood pressure, high levels of "LDL"
cholesterol and triglycerides, diabetes and the reduction in
smoking, all risk factors for stroke.

"By treating the problems we would normally treat, we can
enormously reduce the incidence of stroke," Stein said.

In the last 20 years, new cholesterol-lowering drugs and the use
of the anticoagulant warfarin have greatly increased the
effectiveness of stroke prevention, Stein said.